Healthcare Provider Details

I. General information

NPI: 1689798969
Provider Name (Legal Business Name): GLENN S KROOG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORIAL SLOAN-KETTERING CANCER CENTER 1275 YORK AVENUE
NEW YORK NY
10065
US

IV. Provider business mailing address

MEMORIAL SLOAN-KETTERING CANCER CENTER 1275 YORK AVENUE
NEW YORK NY
10065
US

V. Phone/Fax

Practice location:
  • Phone: 646-422-4313
  • Fax: 212-988-0683
Mailing address:
  • Phone: 646-422-4313
  • Fax: 212-988-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number183916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: